Correcting ocular defects



A Sept. 23, 1941. A. AMES, JR.. ETAL 42,256,587

CORRECTING ooULAR DEFECTS Filed June 1o, 1957 2 sheets-sheet 1 MVR W f s MS a vrs-SR `rm v Sep-t. 23, 1941.", A. AMES, JR., ET AL CORRECTING OCULAR DEFECTS 2 Sheeis-Shet 2 Filed June l0, 1937 `OCULAR SURFACE CURVES m. m O. u

Jf Lomm SURFACE CURVES FRONT Patented Sept. 23, 1941 UNITED STATE connEcTlNc ocULAn Demers Adalbert Ames, Jr., nna Kenneth N. oglennnover, N. H., asslgnors to Trustees ot Dartmouth College, Hanover, N. H., a corporation of -New Hampshire Application June io, 1937, sensi Nn. 147,442

(ci. sii-54.5)

4 claims.

The present invention deals with the correo'- tion of defects of vision including aniseikonia. f

.While Patent No. 1,933,578 .ofJuly 11, 1933, and several copending applications for Letters Patent, as for example Serial, No. 748,788, led October 18, '1934, and No. 67,557, filed March 6, 1936,dis close various modes of correcting practically all 'actually occurring defects of this t'ype, there are certain instances where, properly correcting spectacles are either inconvenient, somewhat unsightly, or offering diiiiculties in manufacture. Also, there are certain ocular defects occurring in connection with aniseikonia, 'as keratoconus, which can not be compensated with spectacles. In another instance, that oi aphakia, it is often very diilicult and sometimes practically impossible to provide satisfactory correction with spectacles alone. l

It isl one of the main objects of the present invention to avoid such difliculties, by utilizing for'eikonic corrections so-called contact glasses, in themselves known for a. long time, but heretofore only used for correcting dioptric defects.

In one aspect of the invention, use is made of the favorable magnification properties of glasses which are very close to the eye. In another aspect, the invention provides dioptric and eikonic correction by combining contact and spectacle glasses, thereby not only simplifying in many inl. stances (as for example in the case of dloptric or eikonic defects of comparatively high degree,

or in the presence of astigmatic and meridional eikonic defects) the manufacture of the required glasses, but also providing correction improved from the medical as well as aesthetical viewpoints.

Further laspects and advantages will be apl parent from the following' description illustrating the genus of the' invention with reference to` several concrete embodiments thereof. The descrlption refers to the drawings in which:

eye. The effective magnitude and shape of the ocular image are determined not only by the properties of the dioptric'image as formed on the retina, but also by modifications imposed upon that image by the anatomical properties and l physiological processes by which the opticaly image upon the retina becomes evident in the higher cortical centers. Hence, generally speaking, aniseikonic defects can be determined only by actual comparison of the ocular images, as for example 'disclosed in Patent No. Re. 19,841, of February 4, 1936. Such defects may be of different character, but for present purposes it will be suilcient to distinguish between over-all" and meridional aniseikonia, the former involving dlmensional changes symmetric to a point, and the latter such changes symmetric to a line or meridian.

diierence between the respective ocular images,

which difference may be expressed as a ratio R.,

usually given as a per cent magnication 100 y Shortly recapitulating the above-referred to disclosures, it will be remembered that aniseilronia is defined as an anomaly of the binocular visual apparatus in which a difference or incongruity exists between the sizes or shapes of the ocular images ofthe two eyes. The term ocular image" describes the nnal Aimpression received in thev I higher brain centers through the vision or an Again, in any meridian, an eikonic correction actually to` beworn, herein also referred to as prescription, will beequivalent to the test correction if the magnlcations in that meridian (the two respective eyes being indicated by subscripts l and r) are related as follows:

where p and t stand for the prescription (actually worn) and test corrections, respectively.

In order to correct 'the dioptric defects, the vergence powers, in any meridian, must be identi- -cal for prescription and test corrections, namely:

y ivf1p=wf1 Since the reference planesy of astigmatism (herein referred to as principal 1'Iieridiii.n.s) and of meridionalaniseikonia (herein `referred to as eikonic meridians") are, generally speaking, in-

dependent, and since the magnitudes of dioptric and eikonic defects, respectively, often. call for quite dissimilar lens properties, the combined correction of dioptric and eikonic defects oifers some The elements oi' corrective eyeglasses, lens sets or combinations according to the present invention are spectacle glasses of the type described in the above-identified disclosures.' and contact.

, glasses of the type to be described herein, bothl elementsv modified -for cooperation according to this invention. l I

A lens combination according to the'presentinvention is diagrammatically shown in Fig; 1, and

l in this gure EL and'ER are the left and right eye respectively, and it may be assumed, i'orl example, that both eyes are ametropic and astigmatic in axes PL and PR, respectively, and

\ thatfthe presence was found of an overall aniseikonia'as well as a meridional aniseikonia-in eikonic meridian VR. It may be assumed that the lefte'yeis lenticularly astigmatic, whereas the right eye has keratoconus. i

lThe measured vergence power defects iVm (sphere, left eye), Vm (cylinder.' left eye), Vm

' (cylinder,y right eye) and the eikonic ratios R0 (overall) and Rm (meridional) indicated in .Fig. 1 must now be 'reproduced in the correction to` be worn by the patient, in accordance with the above relations 1 and.- 2. This is, for example,vaccom plished by providing EL with a contact glass CL having no powder, of a type to be described more 256,56*? f, y i rva high degree of aniseikonia can not be mounted rigidlyienough to provide "reasonably constant size correction, and because such lenses. ink combination withthe power lenses, are heavy, bulky and unsightly, causing the wearer so much. discomfort as to make them' practically useless.

In situations as this, a correction according to the present invention provides a solution; Re-

ferring now. to` Fig'. 2, it may be assumed that the fright eye ER is Aaphalric, whereas EL is normal.

. Assuming, vfor example, that theright eye needs a correction of +10D, a contact lens CRa is fitted to that eye, correcting it more or less approximately. It is, of course, desirable that the contact glass provide,.if at all possible, the exact- 'dioptric correction but, since the "fitting of contact glasses depends on conditions which can noto always be perfectly controlled, a compromise may have to be accepted in the form of a residual dioptrie defect. The patient wearing thecontact glassis then subjected to a test for the determination of the eikonic defect introduced by the -Y .'dioptric contact correction. @In the above in.

in detail' hereinafter, but providing an :overall magnification Mcm, and kwith a spectacle lens ISL providing spherical power V51 and cylindrical power Vm and, incidentally, certainoverall 1 and meridional magnications Miu and Mim. respectively. I'he right eye ERis provided with contact glass CR correcting the keratoconus and introducing an overall magnication Mam. and

with a spectacle. lens SR providing spherical. power Wn andmeridional size correction Msm and, incidentally, an overall magnification Mlm.

f The combined correctionmust be, computed to fulfill the above conditions 1 and 2, and it will A Vequivalent to the test correction, may be. for example, computedfas described in The Journal be-observed that it permits a distribution of the.'

' componentcorrections which renders an'y one element 0f the component comparatively' simplev `of the Optical ,Society of America vol. 26, August, 1936, for the computation. of power and.

ymagnification of a two lens system. In certain cases it will be preferable to determine the proper combination of contact and spectacle glasses emy of refraction as the cornea, does not act as a lens -in the conventional meaning of I that word as in` pirically by ynrst supplyingthe patient with contact lenses vof optimum effect and then testing again for .the spectacle correction which is to take care of the lresidual defect, as will be described more in detail hereinafter ,with referencev to .specific examples. v v

' Another, especially important, embodiment of the present invention isthe correction of aphakia,

wherethe lens has been surgically removed from stance, this test may, for example, indicate a i 20% size difference, the ocular image of the'left eye being to that amount smaller than the `ocular image of the right eye. This aniseikonia. is then corrected by'means of a zeron power magnier SLa before the left eye, provided no residual power defect was found, or a magnifying lens before the left eye maybe combined with a size reducing lens SRa before the right eye (as in- .f dicated in Fig. 2), providing the magnification .f ratiorequired to correct vthe measured aniseikonia. ilorrectionv for any residual dioptric defect can be incorporated in thel spectacle` lenses, asl disclosed in the above-mentioned copendingapplications;

'I'he above-discussed. contact glasses are of the type providing a fluid lens between cornea and contact glass proper;`theindex ofrefraction of the saline 'solution forming the fluid lens being practically equal to that of the cornea, the surface between fluid lens' and glassfreplaces, for optical purposes, thecornea surface, so that-all kindsof spherical ametropia, as well as kers--l f toconus and corneal astigmatism, can be corrected byv contact glasses.l Although this type of contact gl'ass is the only one of practical'im- `partance at the present time. it is understood that the principle of the invention can beapplied to other constructions, as forexample glasses at least partly contacting the cornea.

. Inv this connection, it will be understood'that the fluid lens, for the above-mentioned reason of having for practical purposes the same index yc iicating an optical 'element having' two surfaces separating media of diiferent indices of 'refraction. However, the data of the fluid lens, namelyits thickness, the relative curvature of its surfaces (one of which is'ldentical with the cornea and the otherwith the posterior'surface of the 'one eye, causing a considerable -dioptric defl- "ciency of that eye whereas the other, eye maybe f unimpaired in this respect. The conventional correction ofii the aphakic eye by means of a spectacle introduces a large difference of the ocularv images which often prevents binocular f vision.' `This size diiference can notA very well be corrected with the aid of. size elements mountedv in spectacle frames because lenses correcting contact glass) are nevertheless important characteristics of the entire optical system comprising eye, fluid lens, contact glass proper and, in many instances, aspectacle lens. For this reason, it isnecessary totreat thev nuid lens as la separate structure. i

, Heretofore, only the relative curvatures of the cornea. and of a'contact glass of uniform thickness havebeenpractically utilized for correction` purposes. Although itihas also been proposed to use contact glasses ee'cting a certain dioptric have not only a, zero power effect in themselves,`

but do not change the dioptric condition of the eye for which they are designed.

assess? It was found that those parallel surface contact glasses which are now being manufactured and which could be used with emmetropic eyes increase the image of the emmetropic eye by somewhat less than 4%. Computation shows that an increase of thedepth of the salt solution chamber or fluid lens by 1 mm. increases the magnification about and that an increase of the thickness of the contact glass proper by 1 mm, increases the magnification about 4%.

The magnification effects of contact glasses of various shapes can be conveniently determined by means of charts, as for example similar to that shown in Fig. 3. This diagram presents two sets of curves for contact lensesywhichwill not change the dioptric power of an eye for various glass thicknesses (0.5 and 1.0 mm. in Fig. 3); one set of curves (marked Front surface curves") defines the relation between the radius of the front surface and the magnification,

*whereas the other set of curves (marked Ocular surface curves) furnishes the corresponding curvatures of the ocular surfaces. It should be noted that these relationsv refery only to the magniiication properties; contact glasses made in accordance therewith are suitable for correcting emmetropic eyes for eikonic defects. However, these` relations are also a basis fordetermining magnification properties of contact yglasses having in addition dioptric effects. The values correlated in Fig-'3 are shown in Fig. 4. If, for example, a contact glass effecting 4% magniiication is desired, Fig. 3 indicates that, for t=0.5 mm., a radius r, of '7.8 mm. is necessary and a radius r2 of 6.7 mm.

Fig. 3 is drawn for a fluid lens depth of vw=0.5 mm.; analogous charts can be designed for other w values.

The general principles of the invention having been explained, several embodiments thereof will now be described which will b'e helpful for a better understanding of the possibilities of its practical application.

In the following examples, the clinical record is first given in diopters and magnification, respectively, and then4 the correction consisting either of contact glasses combined with spectacles, or only of contactn glasses dimensioned according to the present invention. Injmost cases, it will be advisable first to make a complete .dioptric andv eikonictest according to the above indicated methods, then theoretically to select contact glasses best suited for the particular case, then again to examine the patient, with the contact glasses in` place, and thereupon to determine the final prescription, either by re-J `taining the contact glasses and computing spectacles accordingly, or, :if necessary, by varying both contact glass and spectacle prescriptions until a combination of optimum usefulness is obtained. y f

Examples l (1) Clinical record (ametropia and-aniseikonia): (Right eye)+10.00 sph., 2.50` cyl. (Left eye)+1.50 sph., 1.00 cyl.

The patient wearing on R. E. a contact glass effecting +9.00 D correction, and on L. E. a zero power contact4 glass effecting a 6% size correction, the following eikonic defect is found:

r1=8.4 mm., 12:8.1 mm. t=0.75 mm., w=0.7 mm.

Spectacle: Standard iseikonic+1.50 sph., -1.00X180,+2% 90 (2) First clinical record (aphakia and astigmatism):

R. E. +9.00 sph., 2.00 cyl. 180

L. E. +1.00 sph., 0.50 cyl. 90

Second clinical record, patient wearing on R."E.

a contact glass partially correcting the aphakia:

L. E. 12% overall, 1% mer. 180

Correction:

R. E. contact: Standard correcting aphakia,

as worn during second test spectacle: standard iseikonic 2.00 cyl.;

180, 1% mer. .180 L. E. contact: Zero power, 8%; dimensions:

r1=8.5 mm., 12:8.1 mm. t=1.0 mm., w=1.0 mm.

R. E. and L. E.: Standard .iseikonic prescription to correct ametrcpia and residual` size diiference as measured in second test.

(4) First clinical record (ametropia and aniseikonia): R.. E.+6.00 sph. L. E.5.00 sph.

Second clinical record, patient 'wearing standard contact glasses correcting the ametropia in each eye:

L. E. 3% overall, 1.5% mer. 180

Correction: j r

Standard contact glasses-as during second test: y

R. E. spectacle: Standard iseikonic 1.5% mer.

L. E; spectacle: Standard iseikonic 4.5%

overall l (5), Clinical record `(highnegree aniseikonia, no

contact' glass:

I appended claims.

` on R. E. indicates:

dioptric defect): R. E. 8% overall, 3% mer. 90 Correction; f R. E. contact: 6% overall; dimensions:

(6) First clinical record (anisometropia): n. +6.00 sph. 1 L. E. +2.00 sph..

Second test with 'standard +6.00 contact lens L. E. y4% overall Correction:

R. E. contact'y standard k-{6.00D L. E. contact 4% overall, dimensions:

c7) First clinical record (aphakia):

R.E .+9.oo sph."

Ltion contacting the eyeball, lens portion joined to said annular portion, and f a uid lens portion between the cornea and said solid portion, the indices oi refraction, surface curvatures and thicknesses of said solid. and :duid lens portionsof said lens means substantially effecting said dioptric test` corrections for the respective eyes and producing in said meridians image magnification ratios which with said dioptric correction, adsaid measured ratios provide in said meridians imagesiz'e ratios of sub-l stantial unity. -3. An ophthalmic lens system for correcting the combined dioptric' andr eikpnic defects of -a f pair of eyes as dened by measured dioptric test corrections and measured ratios of ocular image -sizes in given corresponding meridians ofthe eyes, said system comprising contact lens means for at least oneeye having an annular sclerotic f portion contacting the eyeball, a vaulted corneal,

s olid lens Aortion joined to said annular portion,

` and ailui Alens portion betweenthecornea and said solid portion; a spectacle frame; and lspectacle lens means' having surfaces positioned by said frame at asubstantially fixed distance from the respective eyes; the indices of refraction, surface curvatures'and thicknesses of said solid-and iluid lens portions of said contact lens means and Second test, patient' wearing standard +9.00

,- L. E. 6% overall f Correction: R, E. contact standard +9.00D L.. E. contact, zero power, 6% overall,

sions:

n=8.5 mm., r2 8.0 mm. f tLO mln., w`=0.5 mm.

It should benderstood that the present disclosure isjfor the purpose of illustration only and l that this invention includes 'alljmodicationsand equivalents which fall withinv the scope oi the We claim: i f

I. 1. An ophthalmic lens systemv forl correcting j dimen- Q vthe 'eikonimdefectof apair of eyes as deilned by l measured ratios ofy ocular image sizesin given corresponding meridians of the eyes, said system comprisingx a pair of contact lens means each having an annular sclerotic portion contacting the eyeball, av vaulted corneal solidl lens portion joined to said annular portion, and a `fluid lens portion between the cornea and saidl solid por- 'I tion, the indices vof refraction, surfacecurvatures and thicknesses of said solid and iiuid lens por-1' tions yof Asaid lens 'means producing in rsaid 60 meridians 'image magnication'ratios which with said measured ratios' provide in said meridians image size ratios of substantial unity.

2..An ophthalrniclens system yfor correcting corrections and measured ratios of ocular image 'the combined dioptric and eikonic detects of a pair of eyes as dened by measured dioptric test sizes in given corresponding meridians 'of the i eyes, said system comprising a pair of contact 4 lens means each having an annularsclerotic'pori I `the indices of refraction, surface curvatures,

thicknesses and distances from the eyes of said spectacle lens-means together substantially eifecting said dioptric test corrections for the respective eyes and producing in said meridians im- Iage magnification ratios which with said dioptric corrections andr said measured-ratios provide in vsaid meridians image size ratiosoi substantial' unity. v

4. An ophthalmic lens system for correcting `l the combined dioptric and eikonic. defects oi-a pair of eyes, one of which is aphakic, as dened by measureddioptrictest corrections and measured ratios of ocular image sizes in given corresponding meridians of the eyes, said system comprising vcontact lens means for at least said aphakic eye having an annular sclerotic portion contactingy the eyebal1, a vaulted corneal solid f lens portion joined to said annular portion, *and y a fluid lens portion between thev cornea and said solid portion, the indices of refraction, surface curvatures'y and thicknesses of said contact lens means deiining a collective f lens vcorrecting a major part oi said aphakia; a spectacletrame;

and spectaclev lens means having surfacesv positioned by said frame at a substantially xed vdisl tance from the respective eyes; .the indices of rey fraction, surface curvatures Aand thicknessesy of l saidv solid and fluid lens portions of said contact4 lensmeans and the indices o! refraction, surface curvatures, thicknesses anddistances from the eyes of said spectaclelens means together substantially, effecting said dioptrictest corrections-y for the respective eyes andproducing in said meridians image magniflcationLi-atios which with said' dioptric corrections and said measured ra tios provide in said meridians image size ratios .of substantial unity.

ADEIBERT AMES, Jn.:

a vaulted corneal solid 

